Our allergy office screens and treats patients with asthma and allergic conditions. Our physicians, Dr. Sukanya Kanthawatana, MD, PhD. and Dr. Linda Brown, MD, are board certified allergists. Dr. Kanthawatana has been treating allergic and asthmatic patients in the Pacific Northwest for over 16 years. Dr. Brown joins us in March 2016 after 25 years of distinguished service in the US Army medical corps. She once served as chief of Allergy and Immunology department at the Madigan Army Medical Center.

Our office evaluates, tests and treats all kind of allergic conditions including food, environmental, skin, seasonal and drug allergies and asthma. We do both skin and intradermal tests for allergic conditions.

We administer immunotherapy (allergy shot) to our patients in our office which its specialized injection stations, a comfortable waiting area, and a conference/work room for you to use while waiting the required 30 minutes after your allergy shots. Wi-Fi connection is also available to our patients.

Evaluation and Treatment

Hay fever

Asthma

Sinusitis

Insect sting allergy

Food allergy

Drug allergy

Skin allergy

Urticaria (hives)

Immunotherapy (allergy shots)

Testing

Scratch/prick and intradermal testing for allergy diagnosis

Pulmonary function testing

Laboratory tests for allergy diagnostics

Oral Food Challenge Tests

Skin Patch Tests

What's an allergy?

One of the marvels of the human body is that it can defend itself against harmful invaders such as viruses or bacteria. In some people, the body reacts to harmless substances such as dust, mold or pollen by producing an antibody called immunoglobulin E (IgE). When patients with one of the allergic diseases (such as rhinitis or asthma) are exposed to these substances, the immune system then rallies its defenses, launching a host of complex chemical weapons to attack and destroy the supposed enemy. In the process, some unpleasant and, in extreme cases, life-threatening symptoms may be experienced.

What causes an allergic reaction?

Hundreds or even thousands of ordinary substances can trigger allergic reactions. These are called “allergens.” Among the most common are plant pollens, molds, household dust (dust mites), animal dander, industrial chemicals, foods, medicines and insect stings. An allergic reaction may occur anywhere in the body, but usually appears in the skin, eyes, lining of the stomach, nose, sinuses, throat and lungs — places where special immune system cells are stationed to fight off invaders that are inhaled, swallowed or come in contact with the skin.

What allergies cause fatal reactions?

The most common causes of fatal allergic reactions include severe reactions to foods such as shellfish, peanuts and cod, or to stinging insects such as yellow jackets and imported fire ants.

Who develops allergies?

Allergies can affect anyone, regardless of age, gender, race or socioeconomic status. While it’s true that allergies are more common in children, they can occur for the first time at any age or, in some cases, recur after many years of remission. Although the exact genetic factors are not yet understood, the tendency to allergies, as well as to allergic disease, is linked to heredity.

What are the most common allergic diseases?

The most common diseases caused by allergy mechanisms are those of hay fever (allergic rhinitis), asthma, eczema (allergic dermatitis), contact dermatitis, food allergy and urticaria (hives). Allergy really has different names depending upon where in your body the reaction is occurring. If an allergic reaction occurs in your nose, eyes and sinuses physicians will call it allergic rhinitis. If the allergic explosion is occurring in the lungs, we call it asthma. All of these allergic diseases are inflammatory in nature. That is to say, there is inflammation characteristic of allergy immune mechanisms occurring in those parts of your body when we give the condition the above scientific names.

What's the best method of testing for allergies

The best first step in the diagnosis of allergies is a thorough health history and physical examination. If you have allergy symptoms that occur in association with exposure to certain things, that is highly significant. Allergy diagnostic tests, such as skin tests or blood tests, provide similar information and merely confirm what your health history tells the doctor. If your doctor were to rely exclusively on the results of skin or blood tests (without history and physical examination), you could be diagnosed as having an allergic problem that you don’t necessarily have. Skin tests, in most situations, are preferable because (1) the results are available immediately, (2) they are less expensive and (3) they are more sensitive to subtle allergies. A blood test is appropriate in certain situations, particularly when you (1) cannot suspend antihistamine therapy which can inhibit skin tests, (2) have widespread skin disease making skin testing difficult, (3) are so sensitive to the allergen that the test might be risky or (4) cannot be skin tested for some other reason.

What's an immunotherapy (a.k.a. allergy shot)?

Allergy shots are an effective and safe treatment for people who suffer from a variety of allergic diseases, including allergic rhinitis (hay fever), asthma and insect stings. The treatment – also known as immunotherapy or allergy immunization – works by introducing small amounts of purified substances to which the person is allergic, in gradually increasing amounts. The allergy shots improve the patient’s natural resistance to the allergens and minimize or eliminate the need for medications.

Does allergy shot have side effects?

Like all medical treatments, allergy shots (immunotherapy) can have side effects. Your doctor will discuss this with you in detail. Under no circumstances should you consider allergy shots without at least an attempt at avoidance of the troublesome allergen. For instance, cat allergy shots are no substitute for cat avoidance. Some allergens, though, such as grass pollen, are almost unavoidable. Why is it that frequent exposure to an allergen can increase sensitivity and cause allergic reaction, yet repeated exposure to an allergen in allergy shots helps build ups immunity? Regularly scheduled, repeated exposure to small amounts of an allergen can lead to immunity, whereas infrequent and erratic exposure does not confer immunity but increases the likelihood of producing allergen sensitization. Irregular exposure to allergens can lead to the production of antibodies (called IgE-mediated antibodies). The presence of these antibodies, when exposed to an allergen can lead to an allergic reaction. In allergy shots or immunotherapy, the allergen exposure is closely regulated and given on a scheduled basis. Small amounts of allergens are given over a period of time to build up to maintenance doses. This leads to the production of blocking antibodies (called IgG antibodies) and a decrease in the level of allergic or IgE-mediated antibodies.

Why do I have to wait 30 minutes in the doctor's office after an allergy shot?

While reactions to an allergy shot are normal, a severe reaction (anaphylaxis) while rare might happen. Your doctor and her nurses are trained and experienced in diagnosing the onset of anaphylactic reaction and in providing treatment regiments to alleviate the reaction before it becomes life threatening. You don’t want to experience an anaphylactic reaction while away from a medical facility; hence the need to wait 30 minutes after you are given an allergy shot.

What is asthma?

Asthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems. People with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult. The problem is an oversensitivity of the lungs and airways, which overreact to certain “triggers” and become inflamed and clogged.

What causes asthma?

The cause of the lung abnormality that is asthma is not yet known. Through research, scientists have established that the disease is a special type of inflammation of the airway that leads to contraction of airway muscle, mucus production and swelling in the airways. The airways become overly responsive to environmental changes. The result is wheezing and coughing.

Can asthma be cured?

As yet there is no cure for asthma, but asthma can be controlled with proper treatment. People with asthma can use medicine prescribed by their physician to prevent or relieve their symptoms, and they can learn ways to manage episodes. They also can learn to identify and avoid the things that trigger an episode. By educating themselves about medications and other asthma management strategies, most people with asthma can gain control of the disease and live an active life.

How is asthma diagnosed?

Asthma is sometimes hard to diagnose because it can resemble other respiratory problems such as emphysema, bronchitis and lower respiratory infections. For that reason, asthma is underdiagnosed – that is, many people with the disease do not know they have it and therefore are never treated. Sometimes the only symptom is a chronic cough, especially at night. Or, coughing or wheezing may occur only with exercise. Some people mistakenly think they are having recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma. To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, a thorough physical examination, and certain laboratory tests. These tests include spirometry (using an instrument that measure the air taken into and out of the lungs), peak flow monitoring (another measure of lung function), chest X-rays and sometimes blood and allergy tests.

What does an asthma attack feel like and what happens during an attack?

An asthma episode feels somewhat like taking deep breaths of very cold air on a winter day. Breathing becomes harder and may hurt, and there may be coughing. Breathing may make a wheezing or whistling sound. These problems occur because the airways of the lungs are getting narrower. The muscles that surround the airways tighten, the inner lining of the airways swells and pushes inward, and the membranes that line the airways secrete extra mucus, which can form plugs that further block the air passages. The rush of air through the narrowed airways produces the wheezing sounds that are typical of asthma.

Do I need a referral to see an allergist?

No! If you would like to have a consultation, simply contact us and we will schedule a convenient appointment time for you. Please note, however, that insurance policies may vary and a referral may be necessary for insurance to cover some forms of treatment. If you have questions on what is covered, you should contact your insurance company directly.

Allergy

Eczema

ECZEMA (ATOPIC DERMATITIS)

WHAT IS IT? Atopic dermatitis is a common skin disease frequently seen in allergic patients, especially young children. It usually begins in infancy and consists of itchy, red patches on the skin that may crust, scale or ooze. As many as 50% of patients may outgrow this disorder. In the very young it usually involves the face, torso and outside of arms and legs. In childhood the rash may affect the elbow and knee creases, neck, wrists, ankles and feet. In adolescence, the rash may be more prominent on the hands, feet and face. WHAT CAUSES ECZEMA? The exact cause is unknown; however, it tends to run in allergic families. The skin in people with eczema cannot hold onto water like normal skin. Allergies to common food and inhaled allergens can make eczema worse. It then becomes important to avoid foods that have been identified as playing a role, and good environmental control begun as early as possible. HOW DO YOU TREAT IT? “Soaking and greasing” is very important. First, use only a milk soap such as Dove or no soap at all. Tepid water rather than hot water is recommended as hot water may cause itching. Use of bath oil such as Alpha Keri bath oil or cottonseed oil is good to soak in. Patients may bathe 1-2 times per day. After getting out of the bathtub, pat dry instead of rubbing dry. Immediately apply a moisturizer to lock in the water. Good brands are Vani Cream, Aveeno, CerVa, Exederm, Lubriderm, or another cream that has been prescribed by your doctor. Soft cotton fabrics are recommended as some wool, silk, or polyesters may be scratchy and cause itching. Mild soaps and detergents should be used for washing clothes and fabric softeners should be avoided, as these can be irritating to the skin. Avoidance measures should be implemented when foods or inhaled allergens such as dust mite or pet dander have been identified. Foods which are suspected or have been proven through an elimination diet to aggravate the conditions: dairy products, eggs, chocolate, tree nuts, peanuts, peanut butter, tomatoes, ketchup, and other tomato products, citrus fruits and juices. Oral antihistamines help reduce the itch associated with eczema. It can cause drowsiness but usually clears up after being on the medication for a few days. Apply topical steroids as directed by your physician. Antibiotics may be needed as infections can frequently occur with this disorder in all stages. These infections produce redness and itching and may cause crusting, oozing and ulcers.

Latex Allergy

What is a latex allergy? A latex allergy is an allergy to proteins found in products found in natural rubber latex. What is natural rubber latex? Natural rubber latex is a kind of rubber that is made from the sap of the rubber tree. Natural rubber latex is in many products, especially those used in the hospital. This information is about natural rubber latex and from now it will be written as just latex. Where is latex found? In the hospital latex can be found in gloves, catheters, blood pressure cuffs and many other products. You will find latex in things such as:

rubber balloons (shiny foil Mylar balloons are safe to use)

some baby soothers and nipples

some bandaids

some toys such as rubber balls

condoms and diaphragms

rubber cleaning gloves

Can a latex allergy be treated? There is no cure for a latex allergy. The best treatment is to avoid latex. Treatment is based on the symptoms or reaction you have after you are exposed to latex. Talk with your doctor about medication you can take to reduce allergy symptoms. What can I do to reduce my risks of a latex reaction?

Remove all latex products from your environment. Replace these with non-latex products.

Tell your doctors, dentist, pharmacist and health care workers that you have a latex allergy before any treatments.

Ask to have the first appointment of the day to reduce your risks. Latex particles can float around in the air.

Talk to your employer about how you can work in a reduced latex environment. If you need help to explain this to your employer, talk with your doctor.

You may need to avoid certain foods such as bananas, avocados, kiwi and water chestnuts.

When traveling where medical supplies are limited it is best to carry your own non-latex gloves and supplies.

Are there different levels of reactions to latex? Yes, there are different levels of reactions with a latex allergy from mild to severe. It is hard to tell how severe a reaction will be after contact with latex. A severe reaction may occur even when you have had only a mild reaction in the past. Can my latex allergy get worse? Yes, it can get worse if you continue to be exposed to latex. Can a latex allergy be life threatening? Yes, some people may have severe reactions that are life threatening. A severe reaction to latex requires hat you go to an emergency department. These symptoms can be:

hives all over your body

breathing problems such as wheezing, shortness of breath or a tight feeling in your chest.

If you have had a severe reaction or have tested highly sensitive, you will need to carry medication with you at all times. You also need to wear a medical alert bracelet. The alert bracelet should say: “Severe Allergy to Natural Rubber Latex” How do I get exposed to latex?These are some of the ways you might be exposed to latex:

by direct contact through broken skin or mucous membrane such as surgery or dental work, or blowing up a balloon

during pelvic exams and pap smears when latex gloves are used

having an enema when latex gloves or products are used

using special catheters made from latex

Precautionary steps:

Check with your pharmacist if any product you bought in the drug store has latex in it.

Talk with your surgeon before surgery about reducing your latex exposure in the operating room.

Am I at risk? You are at risk of an allergy if you have used or been frequently exposed to products containing latex. This could be in your home, at your job, or in the hospital or dental office. Children with certain medical problems such as spina bifida have a higher risk for a latex allergy. Allergies to some foods may alert you that you may be allergic to latex. These foods are bananas, kiwi, water chestnuts and avocados. These foods may cause an itchy throat, throat swelling and/or diarrhea. If you have hay fever, asthma or other allergies you are more at risk of developing a latex allergy. How would I know if I am allergic to latex? Latex allergies often start with a rash, hives or swelling on the skin where latex has touched you. This could be on your hands if you were wearing gloves or swelling of your lips if you blew up a balloon. You may have had hay fever type symptoms such as itchy swollen eyes, runny nose and sneezing when exposed to latex. More severe reaction would be breathing problems such as coughing, wheezing, shortness of breath or a tight feeling in your chest when exposed to latex. You may have these symptoms after a dentist puts a gloved hand in your mouth.What do I do if I think I might have a latex allergy? If you think you might have a latex allergy talk with your nurse, doctor or health care worker. It is important to do this when you first come to the hospital/office. You will be asked more detailed questions about the types of products that affect you. To know if you are really allergic to latex you will be given a blood test. Your doctor would talk with you about the results of that test.

Latex and Food Allergies

Natural rubber prepare from the milky sap (latex) of the tree Hevea brasiliensis is a common component of numerous home products and medical supplies, including surgical gloves and catheters. While delayed reactions to latex–containing products are often traced to additives, immediate reactions are closely associated with protein components of the natural rubber latex materials. Allergies to latex and multiple fruits or vegetables have been recently documented to produce patterns of allergic cross-reactivity. While the details of the clinical relationship between latex and food allergies await further study, food allergies have been found to coexist with latex sensitivities for some people. There may be cross-reactivity between latex and the following food and inhalants: Degree of Association or Prevalence:

Mold Allergy

MOLD:

The public’s concern about indoor exposure to mold has increased as they become aware that exposure to mold can cause a variety of health effects and symptoms including allergic reactions.

MOLD FACTS:

Molds are ubiquitous and can cause a variety of health effects. They’re found both indoors and outdoors. Many molds spread by making lightweight spores that travel through air. Some molds make spores and release them regularly; others produce spores that are not dispersed until they are dry. Some molds produce mycotoxins.

INDOOR MOLD GROWTH:

Once a source of mold is present indoors, growth depends on several factors:

Moisture is key for mold growth.

Molds find nourishment from porous building materials, furnishings and dust.

Most molds prefer temperatures between 40– 100 degrees Fahrenheit.

Exterior air is the most common source of molds indoors.

People and pets may also bring mold indoors.

PREVENTING INDOOR MOLD PROBLEMS:

Controlling moisture in the environment may control indoor mold growth.

Run the bathroom fan and/or open a window when bathing.

Vent appliances that produce moisture like clothes dryers to the outside of the building.

Do not carpet bathrooms.

Prevent condensation on horizontal surfaces, on walls and in walls by providing adequate ventilation.

Fungal lung disease due to occupational or recreational exposure to mold

SEEKING MEDICAL ADVICE:

The health care provider may recommend:

General physical exam

Chest x-ray

Pulmonary function test

Allergy testing

Serum mold antibody tests for IgE and IgG

Lung biopsy, if needed

You may need to consult with a specialist in environmental, occupational or industrial medicine or infectious disease or pulmonary medicine.

ENVIRONMENTAL ASSESSMENT:

The environmental assessment includes:

Determining the source and extent of water intrusion.

Determining the types of mold present.

Obtaining recommendations for remediation by a qualified mold remediation contractor.

LIMITING EXPOSURE:

Can it be contained? If the mold growth is over a small area it can be covered with plastic and taped down until remediation can take place. If containment is not possible, relocate residents until remediation is completed and clearance has been given. Use accepted indoor air quality methods to prevent further contamination during:

Environmental assessment

Testing

Remediation

During remediation, every effort should be made not to disturb moldy areas, which may result in further contamination. Workers should use personal protective equipment when cleaning up contamination. Remediation should not be carried out while occupants are present.

CONSIDERATION FOR RELOCATION:

When an area with mold cannot be contained and daily activities will result in exposure to mold, people most at risk for adverse health effects are STRONGLY advised to relocate until mold problem is remediated.

REMEDIATION:

Recommendations for scope of remediation work and procedures should include:

Identifying and removing the source of moisture.

Determining the type of clean-up method.

Assuring workers on site have and wear personal protective equipment.

Erecting containment areas.

Relocating occupants during repair or remediation work.

Disposing of mold debris in regular landfill.

Determining suitability for re-occupancy.

SUGGESTED HOUSING & BUILDING STANDARDS:

When faced with a home or building suspected of having indoor mold growth, the landlord or homeowner should:

Find the source of moisture.

Clean up and dry water damaged structures within 24 – 48 hours of event. Repair or replace damaged materials as needed.

Contain areas with mold so that it will not be disturbed.

Relocate residents until remediation is complete if moldy areas will be disturbed by daily activities.

Relocate residents immediately if they are at high risk of adverse health effects due to mold exposure.

Avoid worker or resident exposure to mold or mold containing dust during assessment, clean up and repair work.

Submit a remediation action plan to building officials.

Consult with an indoor air quality investigator or a qualified mold remediation contractor.

Sinusitis

SINUSITIS: is a condition in which the air-filled spaces in the skull (sinuses) become inflamed. There are many possible causes of inflammation such as viral infection with or without secondary bacterial or fungal infection, allergy, and/or inhalant irritant exposure. Once the nasal lining and sinuses are inflamed, symptoms of nasal and sinus congestion may increase significantly when there is exposure to nonspecific factors such as temperature change, barometric pressure change (especially air travel), odor exposure, hormonal change and emotional stress. Viral upper respiratory tract infection (URI) is the most common cause of sinusitis. Symptoms typically are those of nasal congestion, runny nose, postnasal drip, sore throat, sinus congestion and sinus congestion pain. Three to four days of a yellow/greenish discharge is not uncommon and, if sinus drainage can be maintained and secretions remain thin, there is no need for antibiotic treatment. Studies have shown that 50% of x-ray proven sinus infections will clear without antibiotics as long as there is adequate sinus drainage. Patient with recurrent and chronic sinusitis should be evaluated for conditions that may predispose them to episodes of rhinitis and/or to poor sinus drainage. These may include an evaluation of allergy, work-related exposure to inhalant irritants, infection exposure, defects in immunity, and abnormal sinus anatomy. Finding the cause of sinusitis is essential and may possibly prevent future episodes of sinus infection. RECOMMENDATIONS:

Drink 6-9 glasses of fluid per day.

Avoid use of antihistamines (Actifed, Benadryl, Dimetapp, Claritin, Allegra, Zyrtec, etc.) as these drugs will dry and thicken secretions that inhibit adequate drainage.

Do saline nasal rinses twice a day or more.

Topical nasal decongestants such as Afrin for 2-4 days on a twice a day basis can be helpful to allow saline and/or nasal steroids to enter the nasal cavity to reduce inflammation and promote good drainage.

Decongestant medication such as Sudafed with or without a mucous-thinning medicine such as Robitussin can improve sinus drainage.

Decongestant medications may be used in patients with high blood pressure for 3-5 days as long as the blood pressure can be monitored and is well controlled with blood pressure medication.

Nasal steroid sprays can be used to reduce inflammation.

Antibiotics are best prescribed after the sinus infection has been given a chance to clear with the above measures. Preference is to wait at least seven days after onset or until the sinus infection has begun to trigger a significant asthma episode.

Once antibiotics are prescribed, it is not unusual to require a 2-4 week course of treatment. Chronic sinusitis may require six weeks of therapy.

Asthma

What is asthma?

Asthma (AZ-muh) is a long-term disease that affects your airways. Airways are the tubes that carry air in and out of your lungs. If you have asthma, your airways can become swollen and inflamed. Swelling is a reaction to things that you are allergic to or find irritating. When the airways react, they get narrower and less air flows through to your lungs. This makes breathing hard and causes wheezing. This is called an asthma attack. Attacks are also called flare-ups, exacerbations, or episodes. There is no cure for asthma. Over time and working with your caregiver, asthma can be controlled so that you have fewer symptoms. Taking care of your asthma is an important part of your life. Controlling it means taking medicines as directed by your caregivers and staying away from things that bother your airways such as cigarette smoke. Your asthma may change with time, and may get better or worse. Your treatment plan may need to be changed if your asthma changes. Controlling your asthma should let you keep doing your usual activities. With treatment, asthma can be managed so you are able to live a normal life. What causes asthma? Caregivers do not exactly know what causes asthma. Caregivers know that if other people in your family have asthma, you are more likely to have it. The following are things that may make you asthma symptoms worse, and may trigger an asthma attack:

Allergens:

Animal dander.

Cockroaches and their droppings.

Dust or dust mites.

Molds.

Pollen from plants.

Irritants:

Air pollution.

Cigarette smoke.

Cold air or changes in weather.

Scented products such as perfumes and deodorants, and strong odors from painting or cooking.

Strong emotional expression such as crying or laughing hard.

Stress.

Others:

A condition called gastroesophageal reflux disease or “GERD”. This causes heartburn and can worsen asthma symptoms, especially at night.

Food or beverages containing sulfites such as dried fruits and wine.

Medicines such as aspirin, non-steroidal anti-inflammatory drugs or “NSAID”, and blood pressure medicine such as beta-blockers.

Certain activities can also cause exercise-induced asthma.

Viral or bacterial infections especially of the upper airways.

What are the signs and symptoms of asthma?

You might not have all of these symptoms, or your symptoms may change. Your symptoms may also vary from one asthma episode to the next. Symptoms may be mild during one asthma episode, and severe during another. Common signs and symptoms of asthma include:

Coughing: This is often worse at night or early in the morning making it hard to sleep.

Wheezing: A whistling or squeaky sound when you breathe.

Chest tightness: This can feel like something is squeezing or sitting on your chest.

Difficulty breathing: You may have problems breathing or feell breathless or out of breath. You may feel like you can not get enough air in or out of your lungs.

Most people with asthma have warning signs before symptoms appear. The warning signs are not the same for everyone. Your own warning signs may even be different from time to time. By learning what your warning signs are, you can start treatment sooner. This may keep you from having a serious asthma attack. The following are some of the warning signs of an asthma attack:

Breathing faster than normal.

Difficulty sleeping.

Fast heartbeat.

Feeling more tired than usual.

Itchy or sore throat.

Shortness of breath during exercise.

How is asthma diagnosed?

You may need one or more of the following tests:

Allergy testing: Allergy tests are used to help you learn what causes your allergic reactions. There are many methods of allergy testing such as skin tests, elimination-type tests, and the radioallergosorbent test or “RAST”.

Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Ches

Pulmonary function tests: Pulmonary function tests, also called PFTs, help caregivers learn how well your lungs work. PFTs may also help your caregivers decide on the best treatment for you. During the tests, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers to see how well your lungs are moving and working.

What are the levels of asthma?

Caregivers often classify your asthma to different levels of severity. This is based on your symptoms, how often your asthma attacks occur, and the readings from your peak flow meter.

Mild intermittent:

Asthma symptoms occur twice a week or less.

Nighttime symptoms occur twice a month or less.

Asthma attacks last a few hours to a few days with varying intensity. You may have no symptoms between attacks.

PEF reading variability of less than 20 percent.

Mild persistent:

Asthma symptoms occur twice a week or more but not everyday.

Nighttime symptoms occur more than twice a month.

Asthma attacks may slow your daily activities.

PEF reading variability of 20 percent to 30 percent.

Moderate persistent:

Asthma symptoms occur daily.

You use your quick-relief medicines daily.

Nighttime symptoms occur more than once a week.

Asthma attacks occur twice a week or more, and get in the way of your daily activities.

PEF reading variability of more than 30 percent.

Severe persistent:

You have asthma symptoms throughout the day on most days.

You have symptoms on most nights.

Asthma attacks happen almost all the time limiting your daily activities.

PEF reading variability of more than 30 percent.

What is a peak-flow meter?

A peak flow meter is a small, plastic, tube-like device that you carry with you. This measures how well air moves out of your lungs, also called your peak expiratory flow or “PEF” . Using the peak flow meter correctly will help you better monitor and manage your asthma. Ask caregivers for more information on how to use the peak flow meter. Ask caregivers to explain how the PEF reading variabilitiy can help you learn the level of your asthma severity.

How is asthma treated?

You and your caregiver will make a plan to treat your asthma. You may need any of the following to control your asthma:

Quick-relief medicines: These medicines are taken to quickly open your airways and to treat other symptoms. Quick-relief medicines are also called bronchodilators. Bronchodilators relax the muscles that have tightened around the airways. These allow the airways to open wider, making it easier to breathe. These medicines are used to treat asthma attacks.

Long-term control medicines: These medicines are taken every day to control asthma that does not go away. These medicines help decrease inflammation of the airways. Inflammation is when your airways swell and tighten. Inhaled steroid medicines are commonly used for long-term control of asthma.

How do I find support and more information?

Asthma is a life-changing disease for you and your family. Accepting that you have asthma may be hard. You and those around you may feel scared, confused, and anxious. These feelings are normal. Talk to your caregiver, family or friends about your feelings. You may also want to join a support group with other people who have asthma. Ask your caregiver for contact information for support groups.

Patient Instructions

Controlling Your Allergy

The instructions offered below may seem unnecessarily severe, but experience has shown that an environment free of those substances to which a patient is allergic for even a part of a twenty-four period will be substantially beneficial. It is frequently impractical to control the dust factor throughout the home or the place of work, but the sleeping quarters do lend themselves to rigid control. Also, the dust of the bedroom, for specific reasons, is more allergenic than the dust from other rooms of the home. Pillows, mattresses, box springs, bed pads, blankets, bedspreads, comforters, quilts, stuffed furniture, rugs, and drapes all break down and may produce a substance of allergic importance. DUST:

The room should contain only one bed. Remove all upholstered furniture, rugs, pads, stuffed toys, and dust catching ornaments. Remove all stored clothing, toys, packages and other articles in the closet. The closet should contain only the patient’s clothing in current use and should be as dust-free as the room. It should not be used for storage.

Vacuum the mattress thoroughly, including the box springs, once or twice a month.

Do not use comforters or quilts on the bed. Washable cotton, rayon or other synthetic fiber blankets are best. Washable throw rugs may be used if kept clean.

Keep the room dust free with frequent vacuuming and a weekly wiping down with an oil or damp cloth.

Close and permanently seal all furnace-type outlets in the room; otherwise, the room will become filled with dust-ladened air during the operation of the furnace. Change furnace filters frequently.

Consider a filtration system; either portable for your bedroom, especially if you are a renter, or a central system (an attachment to the heating/air conditioning system). Call or ask us for details.

Cover all pillows, mattresses, and box springs with plastic encasings. Microfiber is best to look for when shopping for encasings. Call or ask us for details

FEATHERS: Feather and/or down pillows, blackest, and mattresses should not be used. Duvet covers on feather/down comforters would be helpful but the cover should be washed every two weeks in hot water. WOOL: No wool blankets or rugs in the bedroom.

New Carpet

TIPS TO ALLEVIATE ALLERGY SYMPTOMS ASSOCIATED WITH NEW CARPET

Many of our patients ask us about having new carpet installed in their homes and what can be done to alleviate symptoms related to new carpet. Our first choice is that you not choose carpet but rather a hard flooring surface like wood, tile, or linoleum. Using area rugs that can be more easily cleaned and replaced can help “warm” up a room. Unfortunately too many people still “have to have” carpet in their bedrooms. For those, we offer you this advice. New carpet can be a source of chemical emissions. In addition to the carpet, the padding and adhesives all emit volatile organic compounds. Some people report symptoms such as upper respiratory irritations, headaches, fatigue, skin rashes, shortness of breath and cough which they associate with new carpet installation. The distinct odor of new carpet is usually attributed to the chemical 4-phenylcyclohexene (4-PC). This chemical can be detected at very low levels, but does not result in an unpleasant odor for everyone. Usually, the odor dissipates within a few days of installation. Recommended Actions:

CONSULT with your retailer before installation. Ask for help in selecting carpet, padding and adhesives that will off gas less and produce fewer emissions.

REQUEST that the carpet installer follow the Carpet and Rug Institute’s installation guidelines.

BEFORE installing the carpet, ask the retailer to unroll and air out the carpet in a well ventilated area.

HAVE the sensitive person leave the premises during and immediately after carpet installation for several days if practical.

INCREASE VENTILATION!!! Open the windows and doors, and use fans to increase the amount of fresh air exchange. Use the HVAC system in fan mode for 2-3 days after installation to clear the air.

USE an air purifier that has a HEPA and Carbon filter to remove particulates and harmful emissions resulting from the new carpet.

Diet for food-induced migraine

Dietary Modifications For Food Induced Migraines

Foods that contain vasoactive amines, i.e., tyramine, phenylethylamine, have been associated with exacerbation of migraine headaches. These are mainly fermented foods with these chemicals being the product formed by bacterial breakdown of amino acids. ELIMINATE:

Chocolate, cocoa – These foods contain large amounts of phenylethylamine and are a food most commonly associated with exacerbation of migraines.

All ripened, i.e., fermented cheeses. Unfermented cheese such as cottage cheese and cream cheese are safe, as is yogurt.

Avocados, bananas, figs – These fruits contain large amounts of tyramine, particularly if over-ripe; there are also large amounts of tyramine in banana peels.

Fermented sausage such as bologna, pepperoni, salami, aged beef, have a high tyramine content.

White wines generally do not contain much tyramine, but more is found in many red wines. There are other chemicals in wine which may contribute to headaches so avoid wine or drink only small amounts.

Beer and ale – Major domestic brands do not contain appreciable amounts. Some imported brands have high levels of tyramine. Non-alcoholic beer may contain tyramine and should be avoided.

Soy sauce contains large amounts of tyramine. Reactions have occurred with Teriyaki.

Dried fish – Fish is safe if fresh. Dried products contain large amounts of tyramine. Caution is required in restaurants.

Soups – Protein extracts. Avoid liquid and powered protein dietary supplements as they contain large amounts of tyramine. Prepared soups generally contain protein as extract and they should be avoided.

Ginseng – This does not contain tyramine but has been associated with headaches.

Shrimp paste must be avoided. Contains large amounts of tyramine.

Caviar can be eaten only if it is vacuum packed and eaten fresh.

Gluten-Free Diet

What is a gluten-free diet? Gluten is a general name for storage proteins found in wheat, rye, barley, and oats. Gluten may cause health problems for some people. A gluten-free diet is a diet including foods and drinks that do not contain gluten. A diet without gluten should be followed if you have celiac (SE-le-ak) disease, or dermatitis herpetiformis (her-pet-i-FORM-is). Dermatitis herpetiformis is a skin condition that is also called DH. A gluten-free diet should also be followed if you are allergic (al-ER-jik) to wheat. People who need this diet to treat a medical condition usually need to follow it for their whole lives. With celiac disease, eating too much gluten may cause you to have diarrhea and stomach pain. You may also be very sad most of time, or become angry easily. It is possible for you to have celiac disease but have no symptoms. Even so, you are still at risk for medical problems. With DH, you may have very itchy rashes which may blister. These symptoms may come and go, but you should still follow a gluten-free diet all of the time. Following this diet may decrease the amount of medicine that you need to take for DH. What can I do to make a gluten-free diet part of my lifestyle? Changing what you eat and drink may be hard at first. Think of these changes as “lifestyle” changes, not just “diet” changes. You may need to make these changes part of your daily routine. Following a gluten-free diet may help you feel better. Choose a variety of items on this diet so that you do not get tired of having the same items every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet. Carry a list of items allowed on this diet with you to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can remind you about the diet. Ask your caregiver, a dietitian (di-e-TISH-an), or a nutritionist (noo-TRI-shun-ist) any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you. Dietitians and nutritionists can also help to make your new diet a regular part of your life. Always read the ingredient labels on products before buying any packaged food. Gluten is found in many foods and drinks. It may not be clear which foods contain gluten. As a general rule, avoid all foods that contain wheat or the wheat-related grains. This includes spelt, triticale, and kamut. You will also need to avoid foods and drinks with rye, barley, and possibly oats. You will need to avoid eating many grain, pasta, and cereal products, and many processed foods. Even while following these guidelines, a gluten-free diet can still be well-balanced, and contain a variety of foods. At first, it may take more time to shop for groceries, and plan and prepare meals. Over time, you will learn what products to buy for a gluten-free diet. For more information about a gluten-free diet, you may want to contact the following: Celiac Disease Foundation13251 Ventura Boulevard, Suite 1Studio City, CA 91604Phone: 1-818-990-2354Web Address: http://www.celiac.org Canadian Celiac Foundation190 Brittania Rd. EastMississauga, ON L4Z 1W6Phone: 1-905-507-6203Web Address: www.celiac.ca What should I avoid eating and drinking while on a gluten-free diet? Breads and starches:

Bread crumbs.

Cereals, including muesli, oatmeal, farina, and other hot cereals.

Couscous

Crackers, and trail mixes with small crackers.

Packaged rice and noodle mixes.

Pretzels.

Some rice cakes, rice crackers, and popcorn cakes.

Wheat or flour tortillas.

Avoid all breads, cereals, pastas, baked items, and mixes that contain these grains or ingredients:

Barley, bulgar.

Cereals with added malt extract and malt flavoring, such as Cheerios&#153;.

Medicines that contain gluten. Ask your caregiver if any medicine that you are taking contains gluten before taking it. Vitamins may also contain gluten.

Non-dairy creamers.

Pickled foods.

Prepared mustard.

Some instant natural beverages.

Some spice blends such as curry powder, ground pepper mixes, and herb seasonings.

Sweets and candies made with certain ingredients (in the Checklist for the Patient).

Checklist for the Patient: Take this list with you when you shop. Look for products with “gluten-free” written on the label. It may not be clear what products contain gluten. This list contains items to look for when reading food and drink labels. Avoid buying products that have one or more of these ingredients: __ Caramel flavoring, or non-United States manufactured caramel coloring. __ Cereal extract or additive. __ Cereal protein. __ Edible starch or wheat starch. __ Emulsifiers. __ Flour. __ Fillers. __ Hydrolyzed, hydrogenated, or texturized vegetable or plant protein (HVP or HPP). __ Dextrin. __ Malt, malt flavoring, or malt extract. __ Mono-glycerides or di-glycerides. __ Stabilizers, such as gluten stabilizers. __ Thickeners, such as modified food starch. __ Vegetable gum or protein, such as oat gum. What can I eat and drink while on a gluten-free diet? On a gluten-free diet, it is very important to read the ingredient label on packaged foods before buying the product. Less-processed foods or things you make yourself should be safer to eat than packaged foods. While oats were not included in a gluten-free diet in the past, newer research finds that oats may be safe on this diet. Ask your caregiver about adding oats to your diet. Breads, cereals, pasta, and baked items made with potato, rice, soy and bean flour may be eaten on a gluten-free diet. Some gluten-free cereals include Arrowhead Mills Corn Flakes&#153;, and Health Valley Rice Crunch-Ems&#153;. Products with garbanzo, potato, rice, soy, and tapioca flour may be eaten. Foods made with nut flour and millet may also be eaten. Brown, white, and wild rice without sauces may be included in a gluten-free diet. Rice products, such as rice cakes, rice crackers, and puffed rice may also be eaten. Rice cereals, cream of rice cereal, and rice polish may be eaten. Corn products, such as cornmeal, corn flour, corn tortillas, or corn cereals may be included in a gluten-free diet. Popcorn and popcorn cakes may also be eaten if they do not contain any gluten ingredients. Ingredients such as corn starch and potato starch are also OK when selecting foods. Gluten-free flours, baking mixes, and baked foods may be selected and included in this diet. Arrowroot powder, amaranth, buckwheat, hominy, quinoa, and tapioca are also allowed on a gluten-free diet. Plain meat, fish, fruits and vegetables are safe to eat while following this diet. Choose fresh, frozen, or canned meat, fish, fruits and vegetables. For packaged items, choose foods that do not have ingredients listed on the Checklist of ingredients to avoid. Ketchup, distilled vinegar, and some mustards are safe to include with meals. Ingredients such as maltodextrin and soy sauce that is labeled “gluten-free” may also be included. Caramel coloring made in the United States, and most syrups and jellies may be included in a gluten-free diet. Some chocolate drinks may also be enjoyed. Read labels on these items to make sure they can be included in your diet. Over time, you may learn how to prepare a variety of enjoyable and healthy meals and snacks. To learn more about recipes for a gluten-free diet and order gluten-free products, you may contact the following: Celiac Sprue AssociationP.O. Box 31700 Omaha, NE 68131Phone: 1-402-558-0600Web Address: http://www.csaceliacs.org What other diet guidelines should I follow? When you eat away from home, ask the waiter, chef or host how the foods and drinks that you are about to eat are prepared. Take a list of the ingredients, foods, and drinks not allowed on a gluten-free diet. Ask if any of these ingredients, foods or drinks are in the meal. If they are, ask for other foods and drinks that are OK to have while on a gluten-free diet. Call your caregiver if you have questions or concerns about your illness, medicine, or a gluten-free diet. Sample diet for one day: Early morning snack: Banana. Breakfast: Soft boiled eggs, gluten-free toast with butter, milk. Morning snack: Gluten-free rice cakes. Mid-day meal: Tuna salad with tomato and lettuce. Apple. Afternoon snack: Carrot sticks. Evening meal: Broiled chicken, baked potato, green beans. Baked apple. Evening snack: Gluten-free rice crackers and sliced Swiss cheese. Risks: With celiac disease, eating too much gluten may cause you to have bloating, diarrhea and stomach pain. You may also be very sad most of time, or become angry easily. Your teeth may lose their white color. Eating gluten will cause problems in your small intestine (bowel). This may make you unable to get the nutrition your body needs, even while following a healthy diet. There may be weight loss, and children may not grow or develop correctly. Following a gluten-free diet when you have celiac disease may stop your symptoms. It may also heal bowel problems, and stop more bowel problems from developing. You may feel better, and healing may start within days of starting the diet. Some people with celiac disease will not improve even if a gluten-free diet is carefully followed. This is because their intestines are too damaged and are unable to heal. You may need to have other treatments, and take medicines to help treat celiac disease. People with DH often have the same intestine damage as those with celiac disease, but not the same symptoms. People with DH who do not follow a gluten-free diet may have a very itchy, blistering skin condition. If you are allergic (al-ER-jik) to wheat and do not follow a gluten-free diet, you may have an allergic reaction. This may include a rash, sneezing, watery eyes and nose, itching, swelling and hives. This may lead to trouble breathing and unconsciousness (unable to be awakened from sleep). The symptoms may begin minutes or hours after eating wheat products, and they may lead to death.

This should be used for a 3 week trial to decide if it makes any difference. If it makes no difference, you probably can forget about food as a cause of the problem.

If the conclusion has been formed that an Low Allergy diet is beneficial, it is then necessary to see what foods may be responsible. A good way to start is to reintroduce those foods least likely to cause symptoms. They are at the top of the list. Then work your way down.

If the low allergy diet is not feasible, you might decide on a 3 week trial following your usual diet at home, but exclude all milk and dairy products (including goats milk) and grains (rice is okay).

When Reintroducing Foods, Start From Top to Bottom. Introduce 1 item every 3 days.

Urticaria and Angioedema Diet

Elimination Diet and Medications in Recurrent/Chronic Urticaria and Angioedema Low Salicylate/Low Preservatives/Low Artificial Coloring Diet: The aim of this diet is to keep the intake of salicylates, preservatives, and artificial colors to a minimum. Salicylates occur naturally in many fruits and vegetables, herbs and spices, and are frequently used in artificial flavorings, perfumes, toothpaste, and medications (aspirin). Preservatives are added to food o prolong shelf life. For example, benzoates are used in fruit juices; sorbate or sulphur dioxide in dried fruits, fruit salads, and sausage mince; nitrites in processed meats; propionate in yeast products; and antioxidants in oils and margarines. Colorings such as tartrazine, erythrosine and sunset yellow are commonly used in commercial foods.

Precautions For Those Allergic To Stinging Insects

Obtain an Epi-Pen or similar device for the self-administration of epinephrine (adrenaline); read the instructions and understand its use. I would be happy to review this with you.

If stung, DO NOT immediately inject yourself with epinephrine; you have time to wait for certain premonitory signs and symptoms such as diffuse itching, particularly in the palms of your hands or soles of your feet, cough, dizziness, sweating and/or scratchy or swelling throat. If these occur, in addition to self- administering the adrenaline you should also go to the emergency room.

If there are hymenoptera nests on your property, they should be removed.

You should alter your behavior to avoid exposure to stinging insects and being stung. These include:

Always wear full shoe coverings (75% of all bee stings occur on the feet).

Solid foods should not be introduced to high-risk infants until four months of age. Dairy delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3 years.

Current Recommendations to Prevent Asthma and Environmental Allergens:

Breast-feed during the first 4-6 months of life.

Administer probiotics to mothers during pregnancy and breast-feeding. They can increase the protective potential of breast milk against development of eczema during the first two years of life. (Probiotics are live microbial food ingredients that are beneficial to health e.g.Lactobacillus)

Delay exposure to cow’s milk and other highly allergenic foods. Avoid solid foods until four months of age.

Avoid exposure to tobacco smoke (also during pregnancy).

Begin dust-mite avoidance early.

Encourage diets rich in antioxidants and omega-3 fatty acids. An Australian study showed that children who ate fish at least once a week were at least 30-70% lees likely to have asthma than children who ate fish less often. (Antioxidants – Vitamin C and selenium mainly provided by fresh fruits and vegetables. Omega-3 fatty acids – found in fish)

Sukanya Kanthawatana, MD, PhD

Allergist

Sukanya Kanthawatana, MD, PhD

Allergy Fellowship: Medical College of Virginia, Richmond, VA
Pediatric residency: University of Florida.
Ph.D. in Pharmacology: University of Florida.

Office

703 Lilly Road NE, Suite 103, Olympia, WA 98506

Appointment Line

360.413.8265

Work days

Monday, Tuesday, Thursday, Friday

Biography

Dr. Kanthawatana trained in allergy at the Medical College of Virginia in Richmond, Virginia after a Pediatric residency at the University of Florida.

She is board certified in Allergy and Immunology. Dr. Kanthawatana also holds a Ph.D. degree in Pharmacology from the University of Florida.

Dr. Kanthawatana enjoys the healthy living of the Pacific Northwest after moving here with her family in 1999.

Linda Brown, MD

Allergist

Linda Brown, MD

Speciality

Allergy and Immunology

Degrees

MD

Training

Allergy Fellowship: Walter Reed Army Medical Center

Internal Medicine residency: Tripler Army Medical Center.

Office

703 Lilly Road NE, Suite 103, Olympia, WA 98506

Appointment Line

360.413.8265

Work days

Wednesday

Biography

Dr. Brown served 10 years as Chief of Allergy/Immunology at Madigan Army Medical Center followed by 3 years as Chief of Medical Specialties at Ft Campbell, KY before retiring this summer and moving back to Olympia. During her 25 years of service in the Army she received numerous awards and commendations for her devotion to patients, medical teaching, and leadership, including being recognized for her care of Soldiers while serving in Operation Iraqi Freedom.

With board certification in Allergy/Immunology and Internal Medicine, Dr. Brown evaluates and manages children and adults of all ages with allergic and immunologic conditions to include allergic rhinitis, asthma, food allergy, sinusitis, dermatitis, urticaria, angioedema, bee sting and medication allergies, and immune deficiencies.

Allergy Medical Assistant

Jennifer T., CMA

Stefanie S.

Allergy Patient Coordinator

Stefanie S.

Hannah A.

Allergy Patient Coordinator

Hannah A.

Sukanya Kanthawatana, MD, PhD

Allergist

Dr. K, as she is affectionately called by her patients, has been practicing medicine for over 25 years. She has been helping patients in Olympia and surrounding communities since 1999.

Linda Brown, MD

Allergist

Dr. Brown joins us after serving 25 years in the US Army including 10 years as Chief of Allergy/Immunology at Madigan Army Medical Center and 3 years as Chief of Medical Specialties at Ft Campbell, KY

Corrie C., RN

Allergy Head Nurse

Christi D., RN

Allergy Nurse

Megan F., RN

Allergy Nurse

Jennifer T., CMA

Allergy Medical Assistant

Stefanie S.

Allergy Patient Coordinator

Hannah A.

Allergy Patient Coordinator

Our Allergy clinic is located in the East Olympia medical center area along Lilly Road.. The Allergy building is located across from Group Health facility just 2 blocks north of St. Peter Hospital. Look for a large 703 number on the building facade. From Lilly Road, turn left into 12th Avenue NE and then right into our parking lot. Use the main entrance in the middle of the building to get to our reception desk.